Summary

Suzanne
O’Sullivan is a neurologist in the British National Health Service. She has a
particular interest in psychosomatic illnesses, and in this book, she covers
what she has learned about them. O’Sullivan provides these learnings mostly
from clinical experience rather than as findings from empiric studies on
psychosomatic illnesses.

Each
chapter is built around one or more case studies that focus on particular
psychosomatic illnesses, and include historical perspectives and various
theories that might explain why they occur.
The
cases O’Sullivan uses presented themselves as seizures, paralysis, urinary
tract troubles, generalized and localized pain, gastrointestinal problems,
fatigue, blindness, and dystonia. Patients sometimes came to her with pre-determined
diagnoses such as epilepsy, Lyme disease, chronic fatigue syndrome, myalgic
encephalomyelitis, and fibromyalgia among others. O’Sullivan is emphatic that
psychosomatic illnesses are not just any presentation of illness that cannot be
linked to a pathological basis. Psychosomatic illnesses arise from “the
subconscious mind [that] reproduces symptoms that make sense to the individual’s
understanding of how a disease behaves.” (p. 83) Illness presentations that are
feigned or self-inflicted (e.g., Munchausen’s syndrome) are not psychosomatic
illnesses in O’Sullivan’s view.Each chapter delves into some particular
aspect of psychosomatic illness relevant to the case study. These include
history (e.g., role of the uterus in hysteria), mechanisms at work (e.g.,
conversion reactions, dissociation), triggers (e.g., stress, loss, personality
traits), factors (e.g., previous illness experiences), illness behavior
disorders (e.g., associating illness to benign physical sensations), and the
higher incidence seen among females. Though O’Sullivan teases out various
characteristics and workings of psychosomatic illnesses, she admits that they
remain vexing to clinicians because, “almost any function of the body can be
affected in almost any way.” (p. 170)

Commentary

Patients who present with psychosomatic
illnesses almost always frustrate health care providers. Their illnesses can’t be
real, the reasoning goes, because their symptoms can’t be linked to an
established pathophysiological cause. They are often given
lower priority by clinicians as a result, and are even, at times, marked as
cases to avoid or given disparaging labels. O’Sullivan is having none of this. In
her view, people with psychosomatic illnesses can suffer every bit as much
people with illnesses stemming from pathophysiological causes and they can be
helped just as much.

To O’Sullivan, people
present with illnesses from either pathophysiological causes or psychosomatic
causes, and neither cause should be privileged over the other. But, sorted out
they must be, because distinctly different approaches are used based on the
distinction between the two. Seizures due to epilepsy, for example, are best
managed with anti-epilepsy drugs whereas seizures due to psychosomatic causes
are best managed with psychiatric and behavioral methods. O’Sullivan makes the
point again and again that failing to discern psychosomatic illnesses not only
results in failure to find resolutions for them, but also exposes patients to
harm from biomedical interventions that would never work (e.g., drugs,
surgery). She goes further to say that just being mindful of psychosomatic
causes of illnesses will not be sufficient. Required also is the right mix of
empathy for the patients whose problems generate psychosomatic symptoms, the courage
to identify health problems as psychosomatic, and firmness to resist patients’
demands to attach disease labels to their illnesses.